不同严重程度脓毒症患者T细胞表面PD-1表达水平差异及其对预后的评估价值

The differential expression of PD-1 on T cell surface in patients with sepsis of different severity and its evaluation value for prognosis

目的探讨T细胞表面程序性死亡受体-1(PD-1)表达水平对脓毒症早期诊断中的价值及预后评估的意义。方法2019年1月至2022年12月于我院重症监护病房的脓毒症患者135例,纳入观察组。依据脓毒症严重程度将观察组患者分为脓毒症休克组(24例)、严重脓毒症组(22例)和脓毒症组(89例)。入院24 h内收集受试者的一般临床资料、实验室指标、T细胞亚群构成比及细胞表面的PD-1分子表达情况。结果在考虑性别、年龄等因素后,CD4^(+)PD-1和CD8^(+)PD-1与脓毒症严重程度呈正相关(P<0.05);脓毒症组、严重脓毒症组和脓毒症休克组死亡率依次升高(P<0.05);C反应蛋白(CRP)、脓毒症休克、CD4/CD8、CD4^(+)T细胞、CD8^(+)PD-1、CD4^(+)PD-1均是脓毒症患者死亡的重要因素(P<0.05);RCS模型分析结果显示CD4^(+)PD-1、CD8^(+)PD-1与脓毒症患者死亡风险均成正相关。结论CD4^(+)PD-1和CD8^(+)PD-1与脓毒症严重程度呈正相关;CD4/CD8、CD4^(+)T细胞、CD8^(+)PD-1、CD4^(+)PD-1均是脓毒症患者死亡的独立影响因素。

The study was designed to investigate the value of PD-1 expression on T cells in early diagnosis and prognosis of sepsis.From January 2019 to December 2022,135 patients with sepsis admitted in intensive care unit of Fengxian Central hospital were enrolled.According to the severity of sepsis,the patients were divided into sepsis group(n=89),severe sepsis group(n=22)and septic shock group(n=24).The general clinical data,laboratory indexes,constituent ratio of T cell subsets and the expression of PD-1 on the cell surface were recorded within 24 hours after the admission.Data showed that after considering sex,age and other factors,the expression of CD4^(+)PD-1 and CD8^(+)PD-1 were positively correlated with the severity of sepsis(P<0.05).The mortality of sepsis group,severe sepsis group and septic shock group increased successively(P=0.002).C-reactive protein(CRP),septic shock,CD4^(+)T cells,CD4/CD8,CD4^(+)PD-1 and CD8^(+)PD-1 were independent risk factors for death in patients with sepsis(P<0.05).Restricted cubic spline(RCS)model was used to analyze the positive correlation of CD4^(+)PD-1 and CD8^(+)PD-1 with the risk of death in patients with sepsis.It can be concluded that CD4^(+)PD-1 and CD8^(+)PD-1 positively correlate with sepsis severity.CD4/CD8,CD4^(+)T cells,CD8^(+)PD-1,and CD4^(+)PD-1 are independent risk factors for mortality in sepsis patients.